2025 Southeastern Residency Conference

Title: Impact of a Pharmacist-Led Glycemic Management Consult Service in Hospitalized Patients  


Authors: Dion Blocker, Michelle Marbury, Mariam Agbe


Background: Diabetes is a major chronic health problem, and its prevalence continues to grow nationwide. If left uncontrolled, patients may develop microvascular and macrovascular complications, which can lead to morbidity, mortality, and decreased health-related quality of life. Wellstar Cobb Medical Center is the only hospital in the Wellstar Health System with a pharmacist-led glycemic management consult service. The clinical pharmacy team manages patients admitted to the hospital and makes a vast number of interventions. Based on the lack of evidence regarding pharmacist-led glycemic management, this study aims to evaluate the safety and efficacy of pharmacy-managed basal-bolus regimens in hospitalized patients. 


Methods: The design of the study is a single-center, retrospective, noninferiority chart review of adult patients admitted to Wellstar Cobb Medical Center. A drug utilization report will be used to identify hospitalized adults who received insulin therapy at Wellstar Cobb Medical Center from January 2018 to July 2024. A maximum of 500 patients will be randomized and included from each treatment group. This study aims to examine the incidence of hypoglycemic events with a pharmacist-led glycemic-monitoring protocol compared to usual care. This study will compare the time to euglycemia after the first abnormal glycemic level, average incidence of hypoglycemic events, total length of stay, continued hyperglycemia after initial regimen, and hospital readmission within 30 days. Data will be obtained from Enterprise Data Analytics due to data query limitations identified in Epic Slicer Dicer. Adult patients with a past medical history of diabetes who are admitted with a blood glucose level greater than 140 mg/dL on basal, bolus, or continuous insulin will be included in the study. Patients using only sliding scale insulin, experiencing critically ill COVID-induced hyperglycemia, with concurrent insulin pump therapy, on hospice, or with consecutive readings of blood glucose 110-180 mg/dL with no more than two BG readings outside the range within 48 hours of admission without a pharmacy to dose basal bolus consult will be excluded from the study. 


Results: The study analyzed 100 hospitalized adult patients divided into two groups: those managed by pharmacist-led glycemic consultation (n=50) and those managed by usual care without pharmacist consultation (n=50). Although not statistically significant, patients receiving pharmacist consultation achieved euglycemia faster (60.7 ± 49.9 hours) compared to the usual care group (93.2 ± 108.6 hours, p=0.05). Additionally, a significantly greater proportion of patients reached euglycemia in the pharmacist consultation group (82%) compared to the control group (50%, p=0.0007). The pharmacist consultation group experienced fewer cases of continued hyperglycemia 72 hours after insulin initiation (38% vs. 66%, p=0.005), which was statistically significant. Length of stay and hypoglycemic events did not significantly differ between groups.

Conclusion: Although not statistically significant, the pharmacist-led glycemic management consult service was associated with improved time to achieve euglycemia in hospitalized patients compared to usual care. Although there was no statistically significant difference in time to euglycemia, hypoglycemic events or length of hospital stay, pharmacist-managed care effectively achieved statistically significant effects on persistent hyperglycemia and achieving euglycemia. These findings support the integration of pharmacist services into hospital glycemic management protocols.